DEP/DUA/1/16/13 (Normalised version)

Thomas Mann

(1777-1778)

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Thomas Mann

Respecting name to be given to disease of this patient somewhat at loss.

Disease consisted of two parts.

Fits with which attacked at uncertain intervals.

And affection of alimentary canal to which more constantly subjected.

In fits [something] indicating epileptic [appearance]

Particularly in abolition of senses with which [attended]

And in state of torpor by which succeeded

Are told that during fits loses sense both of seeing & hearing.

And that after them is even for space of day or two affected with torpor.

From which may conclude that there occurs no inconsiderable disorder of [internal] [senses]

To this may be added that Hysteria [only] disease having resemblance a more frequent [affection] with women

And that upon whole a rare disease with men

Yet although these circumstances in favour of Epilepsy others here arguing hysteria.

Particularly patient according to description affected with globus hysteria by many considered as pathognomonic.

And although absence no proof that affection not hysteria yet presence strong evidence of nature of disease.

Besides this still farther evidence of that complaint in all affections of alimentary canal.

These indeed may be [complicated] with Epilepsy.

Yet at least not frequently combined.

While on other hand constitute essential part of Hysteria.

And here inclined to consider all symptoms of disease to which patient subjected as parts of that affection.

With regard to prognosis may observe that this patient as well as former also dismissed.

And that too after interval considerably longer than usual from any complaint.

Would not however from this infer that radically or certainly cured.

Yet benefit at least such that consider farther attendance for present unnecessary.

This however will more particularly appear from few remarks on practice.

Considering affection to be Hysteria put patient on use of different antispasmodics.

viz Aether & Assafoetida.

From these hoped that by anticipation of fits & by expulsion of wind from intestines.

While at same time by addition of cloves with Assafoetida hoped to keep belly open and thus remove cause of irritation.

Employment of these medicines seemed so far attended with good effects.

But although mitigated symptoms & probably kept off fits for some time did not prevent [retention]

This led me to combine use of pills with tonic.

And for this purpose employed Zinc.

A medicine which at present some practitioners hold in very high esteem others consider as totally ineffective

For my own part must own entertain favourable opinion of it.

And cannot help thinking that even present case affords example of good [affects]

Combined here with Valerian principally to give form.

But in some measure also as Antispasmodic.

First gave it to extent only of three grains [day]

But soon increased to 10.

On this course patient continued for six weeks

And during all that period while symptoms more [constant] gradually left him remained [illegible] free from any return of fit.

Consider him therefore if not cured at least as having obtained very beneficial remission.

In this situation thought it now advisable to give up medicines for some time than to persist in use.

Was therefore dismissed from farther attendance here

And would fain hope that may continue free from affection

Shall not however be surprised to find that subjected to return of complaints.

And in that case shall have recourse not without hopes of success to [same] [measures]